Florida Hospitals Find The Blueprint For Reducing Readmissions

Kelli Kennedy, Associated Press

Florida hospital officials say patients who have been hospitalized recently are 15 percent less likely to be readmitted as hospitals around the country try to improve quality and save money under the Affordable Care Act. Tuesday's report from the Florida Hospital Association comes five years after the state ranked among the worst in the nation for poor health outcomes and high costs.

More than 100 Florida hospitals have saved $25 million in two years and prevented 1,500 readmissions. Surgical complications were reduced by 14.5 percent, saving more than $6 million during a 15-month period at 67 hospitals. Blood stream infections were down 41 percent and urinary tract infections are down 37 percent, saving more than $16 million in reduced costs according to the report.

Medicare officials announced last year they would punish hospitals with hefty fines if they have too many readmissions within 30-days for heart failure, heart attack and pneumonia patients by reducing a portion of the hospital's payments by up to one percent. Under the health care law, the penalties gradually will rise until 3 percent of Medicare payments to hospitals are at risk and will also include hip and knee surgery and chronic obstructive pulmonary disease.

Florida was among 10 states where 80 percent of hospitals will pay fines due to high admission rates. According to an analysis by Kaiser Health News, 135, or 80 percent, of Florida hospitals will be penalized. The penalties are part of a broader push under President Barack Obama's health care law to improve care while also trying to save taxpayers money. Kaiser compiled data from federal health officials about which hospitals in which states will have payments reduced for a year starting on Oct. 1.

But Florida Hospital Association executives said the federal measures don't account for socio-economic difference in readmission rates and point out that Florida's large number of seniors and uninsured residents and high utilization rates make their job more challenging. Their report relied on different methodology than federal health officials.

"I think it's a different portrait. You're comparing two different things...Florida is different than many other states. We have more people uninsured than some state have total population. They're far sicker," said Bruce Rueben, president of the hospital association.

Florida has one of the highest numbers of uninsured residents in the nation with an estimated 3.5 million falling under that category and more than 3 million low-income residents on Medicaid. Both groups typically lack access to primary care doctors who are critical in preventing illness, meaning patients often end up in hospital emergency rooms when they are sicker and more expensive to treat, hospital officials said.

More than 160 Florida hospitals have participated on some level in various efforts and shared their results in meetings, teleconferences and webinars over the past five years. Hospitals said they've improved communication with rehabilitation centers and doctors who follow patients after they're released, as well as connecting individually with patients through home visits or phone calls.

In Miami, Mount Sinai Medical Center started a coaching program to follow-up with patients with congestive heart failure, Chronic Obstructive Pulmonary Disorder and others at high risk for being readmitted.

Central line infections stemming from easy-to-contaminate IV catheters at Orlando Health have dropped 75 percent since 2008 after a team of doctors and nurses created a single protocol for inserting central lines, said hospital President and CEO Sherrie Sitarik. Central lines are catheters that are inserted in the vein or chest and end at the heart.

NCH Healthcare System in Naples went 44 months with no central line infections in its intensive care units "literally copying other people's best practices," said hospital CEO Dr. Allen Weiss.

His hospital also started an early sepsis alert program causing sepsis, or systemic inflammation caused by severe infections, rates to dip from 46 percent to 13 percent in the past few years, he said. Other hospitals around the state have since started similar programs.

The Florida Hospital Association said its working on another pilot program to improve communication between hospitals and nursing facilities to further reduce readmission rates.